Healthcare Provider Details

I. General information

NPI: 1952780470
Provider Name (Legal Business Name): SAFIYA SULEMAN HAFIZI RN, IBCLC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAFIYA IMTIYAZ MOMIN

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 11/08/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 LABURNAM RD
RICHMOND TX
77407-1013
US

IV. Provider business mailing address

4423 LABURNAM RD
RICHMOND TX
77407-1013
US

V. Phone/Fax

Practice location:
  • Phone: 832-566-8949
  • Fax:
Mailing address:
  • Phone: 832-566-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number744210
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127524
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: